Medical Leave: The Exodus of Health Professionals from Zimbabwe.

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Executive Summary

Zimbabwe is faced with a growing problem of the emigration of
its skilled labour. Health professionals in particular are migrating
in search of greener pastures outside the country’s borders.
This has negatively affected the quality of health care offered in
most of the country’s health institutions. This policy paper draws on
research work that was conducted in selected health institutions in July
2002. The study aimed to establish the magnitude of migration of
health pr ofessionals, its causes and to document the associated impacts
on service delivery.

The study is based on a multi-faceted methodology including a representative
survey of health professionals in Zimbabwe, focus groups and
key informant interviews. Attempts to interview professionals outside
the country were less successful.

Zimbabwe has been experiencing a significant brain drain of doctors
and nurses with two dimensions. First, within the country, health professionals
have been moving from the public to the private sector.
Symptomatic of the growing staffing crisis in Zimbabwe’s health sector
is the fact that the public health system only had 28.7% of the required
number of doctors in the late 1990s. Dentists, pharmacists and even
nurses were also in short supply. Of the 1,634 doctors registered in the
country in 1997, only 551 (33.7%) were employed in the public sector.
As many as 67% of public sector nurses are considering moving to the
private sector. Second, the main subject of this paper, there has been an
accelerating movement of professionals out of the countr y primarily to
the United Kingdom, South Africa and Botswana. Some professionals
use the private sector as a stepping stone between the public sector and
leaving the country.

The exact numbers and whereabouts of Zimbabwean health professionals
working overseas is unknown but the Health Minister noted in
2000 that Zimbabwe was losing an average of 20% of its health care
professionals every year to emigration and that each of the country’s five
main hospitals was losing 24 senior nurses and three doctors every
month. He also claimed that 100 doctors and 18,000 nurses had left
since 1998. In 2002, in the United Kingdom alone, 2,346 work permits
were issued to nurses from Zimbabwe. Zimbabwe was the UK’s fourth
largest supplier of overseas nurses, after the Philippines, India and South
Africa. Also unknown is the nature of the linkages Zimbabwean professionals
retain with home although remittance flows are thought to be
extremely significant in propping up the Zimbabwean economy.

What this study shows is that the outflow of health professionals is
unlikely to slow if the push factors do not change. The survey of health professionals showed widespread discontent with working conditions,
workloads and salaries, as well as broader economic and political conditions
in the country. Amongst the key findings were the following:

The vast majority of Zimbabwean health professionals (68.0%)
are considering leaving the country in the near future. In the
case of nurses, the figure is as high as 71%.

The most likely destination (MLD) is the United Kingdom
(29.0%). However, a sizable number prefer destinations within
Africa (mostly South Africa followed by Botswana). Other fairly
popular intended destinations include Australia, the US, New

More than half of the respondents (54.7%) cited economic factors
as a reason for leaving. These included better remuneration
in the intended country of destination (55%) or the desire to
make money to remit home (54%). Illustratively, Zimbabwean
nurses earned an average of Z$18,000 a month in 2001. This
compares extremely unfavourably with the Z$82,600 to
Z$110,625 a month they could earn in Australia and Z$154,000
a month in the US.

There is widespread dissatisfaction with the benefits offered in
the public sector. The respondents argued that the sector does
not offer competitive salaries (87%). Some 68% said they found
it difficult to live on their existing salary and 79% said that it
was necessary to do two or more jobs to make ends meet.

Professional reasons influencing potential emigration decisions
include the lack of resources and facilities (42.9%), heavy workloads
(39.4%) and insufficient opportunities for promotion and
self-improvement (32.2%).

The research results showed that most of the country’s public health
institutions are grossly understaffed and the skeletal staff that remains
are reeling under heavy workloads.

Nearly 80% of the respondents indicated that they lack basic equipment
at their health institutions, such as injections and thermometers.
The absence of such basic equipment makes it difficult for health professionals
to conduct their duties efficiently and this consequently
affects their morale. Nearly 40% of the respondents indicated that their
health institutions do not take adequate measures to protect them from
contracting the AIDS virus. Over 50% of doctors and nurses are constantly
worried that they will get infected at work.

The shortage of suitably qualified health professionals in the countr
y’s public health institutions has increased the workload of those who
remain. For instance, half of the respondents attend to more than 20
patients per shift while only 9.5% attend to less than five per shift. As many as 78% of the health professionals expressed dissatisfaction over
patient load which they regard as extremely high and increasing. They
blamed emigration for the increase. In this case, the migration of health
staff is seen as both a cause of ongoing migration (by increasing workload
of remaining health professionals) and its effect (due to the reduction
of available health professionals).

The study showed that both urban and rural health institutions have
been affected by migration, with those located in rural areas being the
most affected. The situation is better in urban areas which have alter native
sources of medical healthcare in the form of private health institutions.
Besides offering better services to patients, albeit at a higher fee,
the private health sector also provides an escape route for the disgruntled
public health sector professionals who find the salaries offered by
the public sector unattractive. The poor have been negatively affected
since they cannot afford the fees charged at private clinics.

The study shows that existing policy responses are not having a sig -
nificant impact on the retention and return of health professionals. A
speedy resolution to the current economic and political crisis is a prerequisite
for curbing the ongoing migration of health professionals from
Zimbabwe. Policies aimed at retaining existing and re-attracting emigrant
staff are likely to have much greater success in a transformed economic
and political environment.